Symptoms and Diagnostic Delay in Ovarian Cancer: A Summary of the Literature

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INTRODUCTION

Although ovarian cancer is relatively uncommon, it remains the foremost cause of death from gynaecological cancer in Australia (National Breast Cancer Centre [NBCC], 2002) and the western world (Chu & Rubin, 2006:307). As a cause of death from cancer in women, it is fifth in the world (Salzberg et al., 2005) and was the ninth most commonly diagnosed cancer in women in Australia in 2005 (Australian Institute of Health & Welfare (AIHW) & Australasian Association of Cancer Registries [AACR], 2008). In Australia in 2005, 1205 women were diagnosed with ovarian cancer and 888 women died from the disease (AIHW & AACR, 2008). This is despite improvements in treatment in the past 30 years (Bhoola & Hoskins, 2006). In Australia, between 1998 and 2004, patients diagnosed with ovarian cancer had an overall survival rate of 39.8% (AIHW, 2008:179; AIHW, Cancer Australia, & AACR, 2008:7).

Most women diagnosed with ovarian cancer are symptomatic. Only a small percentage of women presenting with early stage disease will have no symptoms. Due to the non-specific and common nature of the complaints caused by ovarian cancer, there are frequently obstacles encountered in obtaining a diagnosis and therefore delays occur. Most women who are diagnosed with the disease are identified only when the disease is widely disseminated (Behtash, Ghayouri, & Fakhrejani, 2008; Bhoola & Hoskins, 2006; Chan & Selman, 2006; Evans, Ziebland, & McPherson, 2007; Fox & Lyon, 2007; Friedman, Skilling, Udaltsova, & Smith, 2005; Kehoe, 2006; National Comprehensive Cancer Network & American Cancer Society [NCCN & ACS], 2004; NBCC, 2005; Olaitan & McCormack, 2007). While diagnostic tools such as abdominal ultrasound, CA125 blood tests (NCCN & ACS, 2004), computed tomography and magnetic resonance imaging (National Breast and Ovarian Cancer Centre [NBOCC], 2008b) might facilitate the diagnosis of clinically suspected ovarian cancer the disease is usually confirmed as a result of histological examination of tissue removed during surgery (Martin & Cherry, 2006; NBOCC, 2008b). At this time, there is no screening test for ovarian cancer recommended for the general public (Australian Cancer Network (ACN) & NBCC, 2004; National Ovarian Cancer Network [NOCN], 2006).

The high mortality rate associated with ovarian cancer is attributed to the fact that it is usually diagnosed at a late stage (American College of Obstetricians and Gynecologists [ACOG], 2002; Chu & Rubin, 2006; Kurman, Visvanathan, Roden, Wu, & Shih, 2008). The stage of the disease at diagnosis has a huge impact on the prognosis (Bankhead et al., 2008). An average of 70-75% of women with ovarian cancer are diagnosed at a late stage (ACOG, 2002; Gaetano & Lichtman, 2004; NOCN, 2006). These women have an associated 5-year survival rate of 20-30%, in contrast to women diagnosed with an early stage disease, who have a 90-95% chance of being cured (ACOG, 2002:237). Given the vast difference in prognosis for those women diagnosed with early disease compared with late stage, it is imperative that efforts are made to ensure earlier diagnosis.

It is critical that nurses are familiar with the subtle symptoms of ovarian cancer as they are ideally placed to facilitate information flow about the symptoms. It has been identified that, in general, women's knowledge of the symptoms of ovarian cancer is limited (NBOCC, 2008c). Nurses have a professional responsibility to provide health education and counseling to members of the community (Australian Nursing & Midwifery Council (ANMC), Royal College of Nursing, Australia (RCNA), & Australian Nursing Federation [ANF], 2008). In addition, nurses play a key role in enabling women to make informed decisions regarding health care (ANMC, 2006, 2008; ANMC, RCNA, & ANF, 2008). Until an efficient and reliable screening test is developed, timely symptom recognition is thought to be one defence against the high mortality associated with ovarian cancer (Ryerson et al. …